Shoulder Instability & Labral Injury

Overview

The shoulder is the most mobile joint in the body, and it pays for that freedom with less built-in stability. The ball sits on a shallow socket, deepened by a rim of cartilage called the labrum, and is held in place by ligaments, the joint capsule and the rotator cuff muscles.

Shoulder instability means the ball moves further in the socket than it should. At the severe end this is a full dislocation — the ball comes completely out, usually forwards, and typically needs to be put back in hospital. More commonly after a first dislocation, or in people with naturally loose joints, the shoulder "subluxes": it slips partly out and back, giving a sense of looseness, apprehension or a dead-arm feeling in certain positions, especially with the arm up and out to the side.

A dislocation often damages the labrum (a Bankart lesion) and stretches the ligaments, which is why younger people in particular have a high chance of further dislocations without good rehabilitation. Labral tears can also occur without dislocation in throwing and overhead athletes, causing deep pain and clicking.

Instability is most common in people under 30, especially those playing contact or overhead sports, and in people with generalised joint hypermobility.

Causes and risk factors

• A previous dislocation, especially under the age of 25
• Contact sports (rugby, football, martial arts) and overhead sports (throwing, swimming, climbing)
• Generalised joint hypermobility
• A fall onto an outstretched arm
• Repetitive overhead loading that gradually stretches the capsule
• Weak rotator cuff and shoulder blade muscles

How we may be able to help

Assessment is essential to understand which direction the shoulder is unstable in, whether the labrum is likely involved, and whether there is a structural problem that needs a surgical opinion. If you have had a recent first dislocation, or your instability is frequent or follows significant trauma, we can arrange an online GP consultation for an MRI and referral to an orthopaedic specialist.

Physiotherapy is the first-line treatment for most instability. The programme builds the rotator cuff and shoulder blade muscles so they actively hold the ball centred, retrains your sense of joint position (proprioception), and gradually reintroduces the positions and loads you need for your sport or job. This is a progressive process over several months and requires consistent home practice. Kinesiology taping can give feedback and confidence in the early stages.

Hands-on treatment is used carefully — we avoid stretching an already loose shoulder — but soft tissue work such as IASTM and cupping can help the muscles that tighten protectively, and our chiropractor treating a stiff upper back can improve how the shoulder blade supports the joint. Our posture scan can highlight blade positioning that leaves the joint vulnerable.

What you can do at home

• After a dislocation, follow the sling and movement advice you were given at hospital
• Avoid positions with the arm up and out to the side (as if throwing) until cleared
• Work on your rotator cuff daily with a light resistance band once advised
• Build shoulder blade strength: rows, and controlled press-ups against a wall
• Avoid heavy bench press, behind-neck exercises and wide-grip pull-ups early on
• If you are hypermobile, avoid "showing off" how far your shoulder can move — it stretches the capsule further